Order Form

MIND BODY LEARNING™

Ordering Instructions:

Please print this form out on your printer
Complete order information
Please send the completed form with your check or money order payable to Kenn Chase

Name: _______________________________________________

Address: _______________________________________________

City, State, ZIP: _______________________________________________

Please indicate quantities for each tape you are ordering:

Video Tapes
___ Tai Chi Short Form	$35.00
___ Tai Chi Long Form	$35.00
___ Tai Chi Short & Long Form	$60.00
___ Tai Chi for Seniors	$35.00
Audio Tapes
___ Feldenkrais for Heart Patient (8 Lessons (30 minutes each)	$55.00
Total	$

	All orders will ship within 3 days of receipt of order via Priority Mail
	Please send Order Form and check, payable to Kenn Chase, to the following address:

Mind Body Learning™
P.O. Box 1073
Woodacre, CA 94973

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